Nelene Fox

Nelene Hiepler Fox (January 9, 1953 – April 22, 1993) was a California woman diagnosed with advanced breast cancer. She requested her HMO to pay for High-Dose Chemotherapy and Bone Marrow Transplant (HDC/BMT) to treat her cancer. Her health maintenance organization, Health Net, declined her request, stating this therapy was an unproven, experimental therapy. She ultimately received her BMT after raising $212,000, but died eight months later, aged 40.

Her estate sued and received $5 million due to the denial. Subsequent research proved that HDC/BMT was a harmful treatment for breast cancer patients, and it is no longer used.

Lawsuit

Her estate brought suit against Health Net, and won a judgment for $89 million against Health Net, including $12.1 for bad faith and reckless infliction of emotional distress, and $77 million in punitive damages. Jim Fox and the estate of Nelene Fox v. Health Net is considered a watershed case in that most health insurers subsequently began approving HDC/BMT for advanced breast cancer.^[1] This judgment was subsequently negotiated down to $5 million.

Consequences

By September 1994, the Federal Employees Health Benefits Program, which covers employees of the United States' federal government, began requiring all of its health plans to pay for HDC/BMT for advanced breast cancer. The State of California subsequently passed a law requiring health insurance to pay for HDC/BMT.

Subsequent research reportedly shows that HDC/BMT for advanced breast cancer does not extend life, worsens quality of life, increases the number of days hospitalized, and costs an additional $55,000 ^[2]

Opinion

Some researchers claim that the politicization of HDC/BMT for breast cancer made it more difficult to recruit women into randomized trials to evaluate its efficacy, as most women did not wish to take the chance of being randomized into the conventional treatment arms of such studies.^[1]

References

1. Mukherjee, Siddhartha (2011). The Emperor of All Maladies. HarperCollins Publishers. ISBN 978-0-00-743581-4.
2. Excerpt from Transplant News, April 30, 1999

Sources

• Anders, George. Health Against Wealth: HMOs and the Breakdown of Medical Trust. Houghton Mifflin Books, 1996, 299 pages, ISBN 0-395-82282-3.
• Mariner, Wendy. Patients' Rights afterr Health Care Reform: Who Decides What Is Medically Necessary?. American Journal of Public Health, September 1994, Vol. 84, No. 9.
• Rodenhuis S, Bontenbal M, Beex LVAM, et al. High-Dose Chemotherapy with Hematopoietic Stem-Cell Rescue for High-Risk Breast Cancer. N Engl J Med. July 3, 2003 2003;349(1):7-16.
• Stadtmauer EA, O'Neill A, Goldstein LJ, et al. Conventional-Dose Chemotherapy Compared with High-Dose Chemotherapy plus Autologous Hematopoietic Stem-Cell Transplantation for Metastatic Breast Cancer. N Engl J Med. April 13, 2000 2000;342(15):1069-1076.
• Tallman MS, Gray R, Robert NJ, et al. Conventional Adjuvant Chemotherapy with or without High-Dose Chemotherapy and Autologous Stem-Cell Transplantation in High-Risk Breast Cancer. N Engl J Med. July 3, 2003 2003;349(1):17-26.
• Schulman KA, Stadtmauer EA, Reed SD, et al. Economic analysis of conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Bone Marrow Transplant. 2003;31(3):205-210.
• Lief M, Caldwell HM. And the Walls Came Tumbling Down: Greatest Closing Arguments Protecting Civil Libertie, pp. 303-53
• Eckholm, Erik. "$89 Million Awarded Family Who Sued H.M.O.". New York Times, December 30, 1993.